早期静脉肝素化在老年急性ST段抬高型心肌梗死患者中的临床应用效果

Clinical application effect of early intravenous heparinization in elderly patients with acute ST-segment elevation myocardial infarction

目的观察早期静脉肝素化在老年急性ST段抬高型心肌梗死(STEMI)患者中的临床应用效果。方法选取2019年1月~2020年5月中山大学附属第三医院粤东医院收治且确定诊断为急性STEMI的100例患者作为研究对象,均拟行冠脉造影和经皮冠状动脉介入术(PCI),采用随机抽签法将患者分为对照组与试验组,每组各50例。试验组患者使用普通肝素,对照组术前不给予普通肝素治疗。比较两组患者的冠脉造影情况、肌钙蛋白I(cTnI)和肌酸激酶同工酶(CK-MB)血清心肌标志物达到峰值时间与住院时间及院外30 d内发生的主要心血管和出血事件。结果试验组患者的血栓抽吸率(28.00%)低于对照组(48.00%),而血栓溶解率(40.00%)高于对照组(12.00%),替罗非班使用率(28.00%)低于对照组(72.00%),无复流发生率(0.00%)低于对照组(12.00%),TIMI 3级血流占比(62.00%)高于对照组(40.00%),差异均有统计学意义(P<0.05)。试验组患者的cTnI和CK-MB血清心肌标志物达到峰值时间与住院时间均短于对照组,差异有统计学意义(P<0.05)。试验组患者的出血发生率(0.00%)低于对照组(10.00%),而ST段回落率(76.00%)高于对照组(54.00%),差异有统计学意义(P<0.05)。结论在老年急性STEMI患者中,采取早期静脉肝素化治疗,可以较为明显地改善冠脉造影情况。

Objective To observe the clinical application effect of early intravenous heparinization in elderly patients with acute ST-segment elevation myocardial infarction(STEMI).Methods A total of 100 patients diagnosed with acute STEMI who were admitted to Yuedong Hospital,the Third Affiliated Hospital of Sun Yat-sen University from January 2019 to May 2020 were selected as the research objects.All patients planned to undergo coronary angiography and percutaneous coronary intervention(PCI).The patients were divided into the control group and the experimental group by random drawing,with 50 cases in each group.The experimental group was treated with unfractionated Heparin,while the control group was not given Heparin before operation.The coronary angiography,the peak time of serum myocardial markers such as troponin I(cTnI)and creatine kinase isoenzyme(CK-MB),hospitalization time,major cardiovascular and bleeding events occurring within 30 days outside the hospital were compared between the two groups.Results The thrombus aspiration rate(28.00%)of the experimental group was lower than that of the control group(48.00%),while the thrombolysis rate(40.00%)was higher than that of the control group(12.00%),the use rate of Tirofiban(28.00%)was lower than that of the control group(72.00%),the incidence of no-reflow(0.00%)was lower than that of the control group(12.00%),proportion of TIMI grade 3 blood flow(62.00%)was higher than that of control group(40.00%),the differences were statistically significant(P<0.05).The peak time of cTnI and CK-MB serum myocardial markers and hospitalization time in the experimental group were shorter than those in the control group,the differences were statistically significant(P<0.05).The incidence rate of bleeding in the experimental group(0.00%)was lower than that in the control group(10.00%),while the ST segment resolution rate(76.00%)was higher than that in the control group(54.00%),the differences were statistically significant(P<0.05).Conclusion In the elderly patients with acute STEMI,early intravenous heparinization therapy can significantly improve the situation of coronary angiography.